Patients who underwent laparoscopic low anterior resection using a novel manta-shaped anastomosis experienced no anastomotic leakage, bleeding, or postoperative ileus in a 68-patient cohort, according to findings published in BMC Surgery.
The mean operative time was 176 minutes, mean estimated blood loss was 67 mL, and the mean postoperative hospital stay was 5 days. Two patients developed postoperative fever related to central venous catheter infection and pulmonary infection, respectively, and anastomotic complications were excluded in both cases.
The study, led by Peng Sun, MD, of Tongren Hospital, Shanghai Jiao Tong University School of Medicine, and colleagues, was conducted between March 2023 and August 2024. Researchers enrolled patients with sigmoid colon cancer or rectal cancer located above the peritoneal reflection and excluded those who received neoadjuvant or immunotherapy. All procedures were performed by the same colorectal surgical team to reduce procedural variability. No patient required a temporary protective ostomy, and all intraoperative air leak tests were negative.
The manta-shaped anastomosis was designed to address stapled "dog ears," structural weak points of the double-stapling technique associated with an increased risk of anastomotic leakage. After rectal transection with a linear stapler, surgeons sutured both corners of the rectal stump toward the midpoint of the staple line using unidirectional barbed absorbable sutures, creating a manta-like configuration. As the researchers stated, "complete removal of the linear staple line from the rectal stump can prevent leakage and thus reduce the risk of abdominal infection and septic bleeding caused by residual 'dog ear' tissue." The trocar of the circular stapler was then inserted through the central portion of the reshaped stump, ensuring that the former dog-ear regions were fully enclosed within the stapler housing during firing, resulting in a true end-to-end anastomosis.
Anastomotic integrity was assessed intraoperatively by inspection of stapled doughnuts and routine air leak testing in all patients. Indocyanine green fluorescence imaging was used before and after anastomosis creation to assess perfusion, and the anastomosis was reinforced with continuous barbed sutures along the anterior and posterior walls. Postoperatively, abdominal drains were removed on day 3 in the absence of leakage, and patients resumed oral intake beginning with liquids on postoperative day 1.
The study lacked a control group using standard anastomotic techniques, limiting comparative assessment of outcomes. The sample size was modest and derived from a single center, which reduced generalizability. In addition, the retrospective design limited evaluation of longer-term outcomes, and the technique was not assessed in patients with tumors below the peritoneal reflection.
The authors reported no conflicts of interest.
Source: BMC Surgery